Homebirth. The word sounds so warm, so inviting, so fresh-baked, so
Mothering magazine. Do it yourself in a soft-sculpture kind of way. Think
"hospital," and soon enough, you're conjuring up bureaucracy and blood
draws, brutal parking and antisocial bacteria. Place, however, might not
be the most important factor in a "good birth outcome," as the jargon goes.
The safest place to have a baby, I remember reading once, was the back
seat of a car.
My doctor told me I was crazy when I said I was planning a homebirth.
"Sure, if everything goes right you could have your baby on a beach," he
said cryptically. In retrospect,
perhaps that's exactly where I should have gone. I might have chosen to do what the other animals do and crawl away to
a secret corner of the woods to have a good scream for three days if the
option were available; barring that, I thought I'd do my grunting at home.
I was part of the 1 percent of birthing women in the United States confident
enough in my own body, or scared enough at what hospitals would do with it,
to make the choice of having my baby in the bedroom. I'd expected my homebirth to give
me a more personalized, more supportive, calmer, less interventionist,
simpler, happier experience than what I would get in a hospital. You hear
all the talk of water babies delivered by naked papas; homebirth, I
assumed, could be customized like a new car. Midwives, I supposed, would
have fewer rules -- and could bend what rules they had to fit the
circumstances. The final moment of ecstasy, I figured, would happen under
the loving gaze of friends and family, and the newborn boy would spring
into the arms of my partner, who would embrace the goo as he placed the
child on my breast.
What I didn't know is that midwifery has come a long way since the
early '70s, when Ina May Gaskin, the matriarch of the contemporary
homebirth movement, rambled across the country in a spiritual Partridge
Family bus, delivering babies in parking lots. I'd read a story from a
tattered 1973 issue of "The Realist" by Raven Lang, another founder of the
homebirth movement, describing mythic flower-power births in which fresh
fruit juices and hash helped the laboring mother along.
I wasn't really hoping to sneak in a bong hit during my labor, but I did want to
avoid the dangerous "prophylactic" measures -- antibiotics, IVs,
episiotomies -- that hospitals dump on patients to fend off lawsuits. I had
definitely been turned off by my first tour of the HMO hospital: a peach
path through suburban anxieties. The kindly nurse who led us through
the Level III facility kept bragging about the many layers of security that
were going to prevent us from having our baby stolen. Then there
were the mishap stories one always hears: an anesthesiologist who put in an
epidural and was somehow an hour's drive away when the anesthesia wore off;
a baby whom a hospital pediatrician mistakenly diagnosed as having his
stomach "on the wrong side," engendering a battery of unnecessary X-rays. I
had started out with a conventional OB-GYN, but had grown increasingly
frustrated with five-minute physician visits and ongoing rounds of blood
work-ups for conditions no one in my entire family history had ever known.
What I got instead from the world of homebirth were herbal teas and
hour-and-a-half conversations along with the ongoing rounds of blood
work-ups for conditions no one in my entire family history had ever known.
These days ultrasounds have replaced bongs, and the wide-eyed and untrained
have moved on to the "unassisted childbirth" movement.
And yes, I know they call it "homebirth," but to tell you the truth, it was
never really my home we were gathering in. Every couple of weeks my
boyfriend and I ambled down to a cozy suburban cottage with a quaint
backyard and built-in family. Appointments with my midwife had a reassuring
routine. "Tea?" she'd ask. "Yes, thanks," we'd respond. There might be a
slice of pie. Then, as the bleeps of a boy playing video games punctuated the
background and a husband popped in or out, we'd talk emotions, get a fetal
heartbeat and eventually be on the road.
Unless, of course, my health actually came up. Then the appointments
involved a different routine -- one epitomized by the rainy Monday, 41
weeks into my pregnancy, when I left the tea bags and chitchat because I
was instructed to head directly to the hospital for some tests, with the
caution that I might have to get induced that day. We quickly and
dejectedly packed our bags and headed for a very unplanned C-section. But
when we got to the dreaded hospital, instead of being greeted by officious
health professionals ready to straitjacket the wayward homebirth couple, it
was a calm, nonchalant staff who gave me tests, a tour of the facility, and
warmly invited me to come back -- even as they sent me home with the
unexpected label "normal."
It wasn't the first midwife-inspired birth scare of the pregnancy followed
by comforts of medicine's more conventional wing; it wouldn't be the last.
Would my baby be born at 13 pounds with the
shoulders of a linebacker, as my midwife once worried? Would my increasingly
variable blood pressure send me into a state of shock? Was my one-
fluid? Tests generally confirmed "no" -- and the tea bags would once again
be offered. But that's the schizophrenic world of midwifery as I
experienced it -- dictums to relax while drawing up detailed maps, in
triplicate, of worst-case scenarios and how to transport ourselves to the hospital. Was it any
wonder my blood pressure only seemed to be rising when my midwife was
measuring it?
I could only laugh at the question that came up over and over again from
well-meaning relatives and slightly concerned friends -- "Is homebirth
safe?" To that I could only answer: "Perilously so."
Like Boy Scouts, it seems, midwives have a motto: "Be prepared." My friends
never really asked whether or not homebirth was complicated. If only I had
known. Never mind the medical work-ups, just making the house ready for
homebirth was no small matter. There was shopping for the special juice I
was supposed to drink to rehydrate myself as labor wore on (if only I had
been able to keep food down). There was the ordering and buying of the
homebirth "kit," a collection of laboratory sundries from some place with a
name like "Moonflower." There were the 10 receiving blankets to be put in a
bag and placed in the oven to warm the child after he left the womb. There
were the myriad herbs and tinctures I searched the city to secure --
alfalfa, hops, cottonroot bark, black cohosh, nettles, you name it; herbs
to lower blood pressure and ease swelling, plants to make the uterus
stronger, teas to bring my iron up, tinctures to ease pain and/or bring on
contractions. There was the misguided attempt to have a "hot tub" delivered
to my living room, should the need arise. And there was the waterproofing
of surfaces, to make sure the water-bag/mucus plug/gooey baby/afterbirth
would not mark up any upholstery, via a product called Chux incontinence pads. Need some? I have approximately an unused case I could
sell you. But I think it was the frozen maxi-pads that finally drove home the
point that home-spinning homebirth is not so simple at all. A molten mass of wetted plastic layered with wax paper was left to defrost on the kitchen counter for a few days. The frosty pads had been scheduled to be my "ice packs" after the birth was over, but ended up a moist mound of uselessness, one final, difficult-
Surely all that prep was worth avoiding all the interventions of a
hospital birth? Well, no. Before the birth, even though my midwife and I
had a legitimate disagreement about what my actual due date should have
been, she encouraged me to move forward with an herbal induction when I
reached the dreaded 42nd week (only the 41st week or less by my
calculation). When labor was finally under way at a rate I thought I could
live with, she broke another of what I thought were cardinal rules of
homebirth, and told me that my labor was not "progressing" fast enough. She
then performed that most pleasant of interventions, an enema, and with a
few seconds of "informed consent" that I remember as something along the
lines of "this won't hurt a bit," offered a homeopathic dose of blue cohosh to supposedly get the labor going again -- and broke the bag of waters.
Without water as a cushion, my baby's head plunged onto my cervix, which of course led to an early desire to push that swelled my cervix closed again and led me to the hospital, where I necessarily cascaded through the rest of the usual interventions: IVs with Pitocin and
glucose and water, an intrauterine pressure device, catheter, antibiotics,
monitoring devices screwed onto the baby's head and an epidural -- well,
two epidurals. The first one wandered off my spine and gave me a sweet high
until we all realized something was very wrong and the epidural had to be
rebooted. It was 12 hours after my drive to the hospital, desperately
panting all the way, that I finally got to turn off the pain medications
and do what I'd been waiting a half-day for: push the baby out on my own.
More surprising than the fact that the baby was born perky, pink and
Apgar-ready was that the hospital bore little resemblance to the halls of
horror I'd been reading about. I didn't get my ceremonial staph infection;
I didn't feel the place was a sterile, inhuman baby factory conceived to
control women's destinies. What I got was 24-hour breast-feeding assistance;
night nurses, each with a new helpful nipple squeeze; someone to make my
meal, albeit an unsettling one, and take that meal away (thank God). Yes,
my insurance company was paying thousands a day for the services, but those services
did come in handy: I had one kindly nurse who offered extra measures to
help me through the frightening first defecation. Would my midwives have
come over at 4 a.m., after my three days of labor and fourth day without
sleep, and taken the baby for a few hours so I could get some of the most
necessary rest of my life? I doubt it.
(My midwife, as it had turned out, had to leave her advocacy perch at my bedside
to attend to her other client in labor just five minutes before the pushing
phase of my own labor began. The phalanx of residents and nurses who had swarmed around my bed during parts of the night somehow evaporated. Which left a room with
only me, my partner and my best friend, holding a mirror for what seemed
like entire minutes as the baby's head began to crown. When he arrived, it
was, as they say, the best moment of my life.)
I had plenty of time to relive the glory as I reclined for three days on
freshly laundered hospital sheets with TV and phone at the ready. Why had I
chosen homebirth in the first place? It wasn't the "home" part of it -- I
rent a city apartment, and it's not exactly the height of comfort and ease;
it's more like a repository of unfinished business and moldy corners. Was
it an act of protest? If so, I'd come to the wrong march. I found out the
hard way that my midwife's reasons for giving me a homebirth appeared to be
far different from my reasons for wanting one. If I wanted nature to take
its course, and was willing to take the necessary risks to let that happen,
she wanted nature to take her course -- a paved road through the woods.
Though I may have been dropping out of one system, I was also tumbling head-first into a new one, with its own ready-made worldview and marketing
tie-ins. Cloth diapers? Check. Circumcision? Negatory. But do I have to
claim I'm in sync with the entire history of man as I make these consumer
choices? Along with the fluffy organic cotton can come a fuzzy thought
process: The late 20th century midwifery movement is based on a logic that
isn't always practiced in its literature. You get rampant speculation when
some of its greatest voices call up history and anthropology to bolster
their views. Suzanne Arms, the author of "Immaculate Deception," writes
that the "birthing woman has lost touch with her ancient female lineage,"
which is why she fears the pain of birth. Was she there to hear my
ancient female lineage complain? As for the birthing practices of
traditional cultures, which always come in handy when criticizing Western
medicine, how many women would enjoy the method that Midwifery Today
reports the Guarani of northern Bolivia use to get the placenta out: making the
mother gag on a chicken feather?
I'll take the hospital, and not because anyone threatened me with a
chicken feather. Like many unwieldy institutions, it's big enough to host
dissenters and crazies, the tenured as well as the young -- who at least
bring humor along with their lack of experience. The homebirth world seemed
surprisingly staid and monolithic by contrast, with midwives stuck in the
same era that spawned their medical ethos. The culture clash became most
apparent to me during labor, when I informed my midwife over the phone what
kind of entertainment I was using to get me through contractions -- some
campy musicals from my childhood that still had some ironic value. To which
she responded with an earnest tip from the PBS circuit: "You know what's a
good musical you should see? 'Riverdance.'"
It made me suspicious. I mean, why are so many self-help birth books pink?
And why do homebirth teachers like to refer to birth as "sacred"? Can
"getting in touch with the rhythms of nature" with a good walk on the beach
really initiate labor? I logged miles and miles in fruitless pursuit.
Homebirthers themselves appear to be an amazingly intelligent group of
people from the small sample I know -- skeptics who are often health professionals taking a break from irritating hospital routines. Why
are they bathed in a culture of euphemism? Homebirth books love to point
out the dangers of hospitals while minimizing the "failure" rate of
homebirth. I had a hard time finding homebirthers willing
to share the gritty details of their hospital transfers; there's a kind of
"homebirth macho" that equates hospitalization with capitulation.
Yet that "capitulation" is practiced all the time. Caution is the keyword
for midwives, many of whom are uninsurable. Though they claim the problem
with doctors is that they rely too heavily on technology that was devised for
emergencies, in retrospect, I think that technology may be doctors' primary
strength. Unlike midwives in a homebirth situation, doctors can be calm
even up to the last minute. With fetal monitor safely screwed into my son's
skull, everyone in the room could finally believe he was alive and well and
would eventually make his way out. Signs that had my midwife worried were
not causing panic among the residents treating me. Midwives have to be
trained to think at least hours, if not weeks and months, in advance. They
say they have to believe the best, but clearly they also must envision the
worst.
The worst, as it turned out, was a frequent topic as my pregnancy wore on.
I had just wanted reassurance that I could deliver my baby at home, even if
he was going to be late. The books I'd borrowed from my midwife's library
and read at her insistence had all reasoned, as did I, that "due dates"
were a normalizing fiction. But what I was finding from my homebirth class
and my two midwives as I headed toward the end of my pregnancy was that "post-dates" pregnancies are considered risky these days, even though the
numbers say that from 40 to 43 weeks the risk of mortality per 1,000 babies
increases from 2.3 to only 4. With constant checking of my vital signs and those of
my "post-term" baby, I truly believed I would be one of the 996 moms whose baby beat the odds. Was I so crazy?
Apparently I was, according to my midwives, experts whose opinions were
just as difficult to question as any other medical authority. When told my
family history (my own mother had eight consecutive late-but-normal
pregnancies; all my siblings have had prolonged pregnancies), my midwife's
assistant told us she'd never seen a pregnancy go post-dates that wasn't
a miscalculation. If you say so.
In the hospital, I made a habit of refusing treatments. With midwives, it's
they who refuse you. Is your baby big, small or breech? When a midwife
tells you her rates of hospital transfer and Caesarean, do you know what
kind of population she's talking about? Mine had a rate of something like
one in 10, though she kept insisting hospital transfers were "rare." But a one-in-10 transfer or Caesarean rate is not a minimal
percent of the population. And the
population she was talking about doesn't drink, smoke, is generally not
overweight and has been eating meticulously for nine months; otherwise she
wouldn't have taken them on. Not to mention that most midwives' customers, I
would hazard a guess, are not first-time mothers.
Hospitals, on the other hand, have to accept the great unwashed.
And hospitals' numbers reflect it: For low-risk pregnancies -- according to a
report from the Institute for Childbirth and Family Research in Berkeley, Calif. --
hospitals are more dangerous than homes. Other statistics on both certified
nurse midwives and direct-entry midwives (those who work outside hospitals) back up the idea that homebirths are safe, as are hospital births with CNMs. But to my mind, it's the
overriding concern over safety that has led midwifery down a frightening path,
one where caution replaces common sense. Defense is an understandable
posture, of course, given the years of persecution direct-entry and
certified nurse midwives have faced from the medical profession. While
hospitals have adopted many of the groovy innovations midwives and birth
advocates had been clamoring for, hospitals and doctors have also done
their best to put midwives out of business, in many cases actively
fighting laws that would allow midwives to simply do their work. Midwifery's
response, however, has been a problem all its own. Standardizing its own
practices and adopting its own codes has led to the kind of hard-and-fast
rules midwives of the '70s wanted desperately to avoid. Perhaps midwives
have been obsessed by doctors for so long that they've become the thing
they hate.
That's what I was left to ponder after my own homebirth gone awry. In the
weeks following my "post-dates" pregnancy that turned out to hatch a "pre-term" infant with vernix
coating his newborn body -- an indication that
he was not post-mature at all -- I was still entertaining the quaint notion
that bringing health professionals into my home would somehow neutralize
them. But even after the child was born and deemed healthy, my midwife
assistant's visit followed the familiar narrative. First there was chatter;
maybe I offered some tea. She would make some wry comment. Then came the
bad news: and there was always the bad news. This time, the midwife found
my baby was too cold by a few tenths of a degree. She took and re-took his
temperature and I panicked for an hour after she left, until I had the
forward-thinking idea of checking the thermometer on myself. I was an
entire degree lower than my child, and so was my partner.
Yet I have to respect my midwife for overcoming her fears and attempting to
deliver my baby at home, though it did, of course, climax with a dramatic
evening transport to the hospital. The picture of me with my legs crossed
in a hilarious attempt to keep the baby inside me as we drove through
winding San Francisco streets in foggy darkness is my fondest memory of the
whole extravaganza -- the 20 minutes that could qualify as a legitimate
sequence in an action flick. It made me realize that what I wanted from my
birth experience was anything but soft-sculpture. That specter is something
few midwives in the late '90s are willing to let themselves consider.
Later, my midwife was way off the mark when she tried to empathize by
saying "I'm sorry you didn't have the birth you wanted." She couldn't have
known I actually did.
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